Electronic Thesis and Dissertation Repository

Degree

Doctor of Philosophy

Program

Nursing

Supervisor

Dr. Catherine Ward-Griffin

Abstract

The purpose of this study was to critically examine the social organizations within Canadian non-government organizations (NGOs) in the provision of HIV/AIDS health work in Tanzania. Using a post-Marxist theoretical framework, I employed the tools of institutional ethnography to understand how distinct forms of coordinated work are reproduced and embedded within the institution of Canadian NGOs at the local site of lived experiences.

Multiple, concurrent methods, including text analysis, participant observation and in-depth interviews, were utilized. Data collection occurred over approximately a 19-month period of time in Tanzania and Canada. Interviews were conducted with health work volunteers, NGO administrators and staff and bilateral agency employees. Participant observation was used to record insights from the interviews as well as observations of the participants’ everyday work experiences. Further, since text-based forms of knowledge are essential in understanding ideologies, working activities, and power relations of an institution, text-analysis was used as a data collection technique.

The findings, implications and recommendations of this study were theoretically derived. Neoliberalism and neo-colonialism ruled the coordination of international volunteer health work. In this study, three social relational levels were exposed: interpersonal social relations, organizational social relations, institutional social relation. Gender, race and class were the interpersonal social relations that advantaged the international volunteer health workers as ‘experts’ over the local community. 'Volunteer as client', ‘experience as commodity' and ‘free market evaluation' were the organizational social relations pervasive in talk and text. Neoliberal ideology and the third sector were interwoven and worked together to inform values and activities of international health work volunteers. Finally, the three institutional social relations, ‘favoring private sector interests’, ‘hegemonic accountability’ and ‘reality disconnected from rhetoric’ exposed the conflation between aid and trade bilaterally. This study has extended our understanding of the ways in which health work volunteers, NGO administrators, and bilateral agency employees come together to produce health work in Tanzania. The findings illuminate the need to generate additional awareness and response related to social inequities embedded in international volunteer 'health work' beyond who constitutes ‘the expert’. Health promotion strategies include challenging the role of neoliberalism, including foreign trade, in the delivery of international aid.


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